* GNOME:  G = Goals,  N = Needs,  O = Objectives,  M = Methods,  E = Evaluation

Please add additional narrative details or comments if you wish:

II. 2. Overview of Section II Back to Top

Describe evidence that your curricula were developed using a scholarly approach. (For ideas, review Glassick’s article, Acad. Med. 2000;75:877–880).

Describe any scholarly products that were presented or published, or adopted for use in other programs, as a result of your curriculum development activities: (see Standardized Template For Reporting Educational Scholarship )

SECTION III: MENTORING/ADVISING

III. 1. Description of your Mentoring and Advising Activities Back to Top

Mentoring and Advising Grid

In 1-2 pages, describe your mentoring philosophy and the process by which you typically mentor junior professionals:

List of mentees from whom letters are appended:

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III. 2. Overview of Section III. Back to Top

Describe evidence that your mentoring and advising activities have been developed using a scholarly approach: (For ideas, review Glassick’s article, Acad. Med. 2000;75:877–880).

Describe any scholarly products which were presented or published, or adopted for use in other programs, as a result of your mentoring and advising activities: (see Standardized Template For Reporting Educational Scholarship).

Use the space below to share any reflections on mentoring and advising activities that are not covered above:

SECTION IV: EDUCATIONAL LEADERSHIP/ADMINISTRATION

IV. 1. Description of Educational Leadership and Administrative Activities Back to Top

Answer the questions separately for each program you lead or have led. You may refer to previous sections of the EP if appropriate. Examples of leadership roles in education include fellowship/residency/clerkship director or associate director, site director, continuity clinic director, leader of an education subcommittee/curriculum committee, project director on a training grant, director of a faculty development program.

Narrative description of the program and its impact (refer to table by activity number):

Evidence of scholarly approach to this role/task:

Results of evaluation of your role by outside agencies (e.g., ACGME, LCME, NBME, funding agencies)

List of stakeholders for whom letters are appended (e.g., institutional/departmental leaders, learners, peers, community partners):
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2
3
4

IV. 2. Overview of Section IV Back to Top

Describe evidence that your educational leadership or administrative activities have been developed using a scholarly approach: (For ideas, review Glassick’s article, Acad. Med. 2000;75:877–880).

Describe any scholarly products which were presented or published, or adopted for use in other programs, as a result of your educational leadership or administrative activities: (see Standardized Template For Reporting Educational Scholarship)

Use the space below to share any reflections on educational leadership or administrative activities that are not covered above:

SECTION V: OTHER INFORMATION

V. 1. Professional Reviewer/Moderator Activities at the National Level Back to Top

Describe the impact of these review activities on your philosophy or practice as an educator (identify by activity number).

V. 2. Education grants funded Back to Top

Title


Your role


Funding source

ÿ National/international     ÿ Regional    ÿ Dept/institutional

V. 3. Education Awards/ Honorable Mentions Back to Top
List, indicate if award is international/national/regional/institutional/departmental and describe briefly.

V. 4.Publications and Scholarly Products Related to Education Back to Top

Provide list with full citations. See Standardized Template For Reporting Educational Scholarship for information to include. Do not include clinical or basic science research publications.

V. 5.Workshops and Peer-reviewed/Invited Presentations on Educational Topics Back to Top

Provide a list with full citations. See Standardized Template For Reporting Educational Scholarship for information to include. Do not include presentations whose purpose is to report on or teach about clinical or basic science research; include only presentations about education. Include presentation location: departmental, institutional, regional, national or international audience.

V. 6. Professional Development in Education Back to Top

List in the grid below any conferences, certification or degree programs, or other educational activities that you have attended as a learner (not a teacher). Include ONLY those which have made a significant impact on your philosophy or practice as an educator. [A more comprehensive list should be included in your curriculum vitae.]

Describe the impact of each development activity on your philosophy or practice as an educator (identify by activity number).

STANDARDIZED TEMPLATE FOR REPORTING EDUCATIONAL SCHOLARSHIP
(For use in any section of the EP)

Publications:

        Type: Letter to editor, case report, case series, review article, original article

       Invited or peer reviewed?

       Where published:

       Impact factor of journal (if available)

        Citation Data (if available)

Presentations:

       Type: Workshop, long or short platform presentation, poster, other

       Invited or peer reviewed?

       Where presented:

       Purpose of the presentation:

Evidence of disseminated use of the product:

       Description of product

       Where was it adopted?
            Other departments within institution
            Other institutions

       Evidence of how it was adopted

Glassick’s six criteria for a scholarly approach/scholarship (Acad. Med. 2000;75:877–880) provide a useful structure for systematic description of an educational activity:

1. Clear goals: stated purpose, realistic objectives, important questions
2. Adequate preparation: understanding of literature, appropriate skills, needed resources
3. Appropriate methods: choice of methods that match goals, effective use and flexible application of methods
4. Significant results: goals are achieved, results are important, field is advanced
5. Effective presentation: presentation well organized, forums appropriate, message clear and sound
6. Reflective critique: work critically evaluated, supported with good evidence, evaluation used to improve future studies